Transcript DDV Food - Danske Regioner

Reduce – en forskningsklinik
Universitetsparken 2, 4000 Roskilde
Overlæge Søren Toubro - www.reduce.dk
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- for OS er vægttab en udfordring
Læs mere på www.zoo.dk
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“Livsstil- og medicinsk behandling “
 - Farmakologi
 - Livsstil
 - Sociale/psykiske årsager
Fedme: behov og behandling i DK
500.000
450.000
400.000
350.000
300.000
250.000
200.000
150.000
100.000
50.000
0
BMI > 30
Medicin
Kirurgi
Kur
Vægttabseffekter
Pulverkur: 1 – 2 kg/ uge i 8 uger, herefter ca. 1 kg/uge
Kost:
Motion:
½ kg/uge, når fedtenergi %
10E%
0 – ½ kg/uge, ved + 30 min dagligt
Medicin: 2 – 5 kilo efter 1 år
(ud over vægttabet ved kostomlægning)
Kirurgi:
20 – 30 kg gastric by-pass
Effekter af vægttabsbehandling
NON-Kirurgisk(3-5 kg) Kirurgisk(>20kg)
Dødelighed
?
+
T2D
+
+++
Arteriosclerosis
+
++
Hypertension
+
+
Dyslipidemia
+
++
Søvnapnøe
+
++
Farmakologi
 ‚Good news: The FDA has approved pills that help you
lose weight by making you feel full. The recommended
dosage is five thousand pills a day.‛ – O’Brien
Den medicinske behandlings historie
Approval/With drawel Drug
Serious adverse effects
1893/
Thyroid hormone
hyperthyroidism
1933/
Dinitrophenol
cataracts, neuropathy
1937/1971
Amphetamine
addiction, psycosis
1965/1972
Aminorex
Pulmunary hypertension
1973/1997
Fenfluramine+phentermine
Cardiac valvular insuff.
1960/2000 (USA)*
Phenylpropanolamine
Hemorrhagic stroke
2006/2009
Rimonabant
Depression/suicidal ideation
1997/2010
Sibutramine
Cardiovascular disease
*Phenylpropanolamine is still available in some European countries
Modified and updated after Bray 2003¹
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Hvor skal den medicinske behandling virke?
CNS
Thermogenic
Upper gastric
Lower gastric
Præparater i DK:
1) Xenical/Alli
2) Regenon
FDA-Approved Medications
Weight Loss
Assessed
(Weeks)
Mean Weight Change
in Treated Patients
vs Placebo (95% CI)
Source of
Data
Characteristics
of Study Patients
Sibutramine*
Existing
meta-analysis
of 29 RCTs
Mean age: 34-54 years;
53%-100% women;
average BMI, NA
52
-4.45 kg (-5.29 to -3.62 kg)
Orlistat*
Authors’
meta-analysis
of 22 RCTs
Average age: 48 years;
73% women;
average BMI, 36.7 kg/m2
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-2.75 kg (-3.31 to -2.20 kg)
Phentermine
Existing
meta-analysis
of 9 RCTs
Average age: NA;
78% women;
average BMI, NA
2-24
-3.6 kg (-6.0 to -0.6 kg)
Diethylpropion
(amphetamine)
Existing
meta-analysis
of 13 RCTs
Average age: NA;
80% women;
average BMI, NA
6-52
-3.0 kg (-11.5 to -1.6 kg)
Medication
*FDA-approved for long-term use in weight loss.
NA=not available.
Li Z et al. Ann Intern Med. 2005;142:532-546.
New- potential Medications
Weight Loss
Assessed
(Weeks)
Mean Weight Change
in Treated Patients
vs Placebo (95% CI)
Source of
Data
Characteristics
of Study Patients
BLOOM
Mean age: 34-54 years;
53%-100% women;
average BMI, NA
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-4.45 kg (-5.29 to -3.62 kg)
Average age: 48 years;
73% women;
average BMI, 36.7 kg/m2
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-2.75 kg (-3.31 to -2.20 kg)
Amylin
Hormon inj
Average age: NA;
78% women;
average BMI, NA
2-24
-3.6 kg (-6.0 to -0.6 kg)
Topiramate
Average age: NA;
80% women;
average BMI, NA
6-52
-3.0 kg (-11.5 to -1.6 kg)
Medication
Lorcaserin
5-HT2c agonist
ONEXA
Phentermin +
Topiramate
*FDA-approved for long-term use in weight loss.
NA=not available.
Li Z et al. Ann Intern Med. 2005;142:532-546.
Slide No 12
Liraglutide combined with metformin leads to greater weight
loss than metformin and SU
Change in body weight (kg)
1.0
0.0
-1.0
*
* p<0.0001
vs. glim + met
-2.0
-3.0
-2.8 kg from
baseline
-4.0
0
2
4
6
8
10
12 14 16
18 20 22
24
26
Week
Glimepiride 4mg + met
Metformin only
Liraglutide 1.2 mg + met
Liraglutide 1.8 mg + met
• Patients lost 2/3 of weight as fat (predominantly visceral)
Nauck et al. Diabetes Care 2009; 32; 84–90. (LEAD 2)
Effekten af livsstilsintervention (n=3234) DPS
Placebo
Metformin
Weight loss (kg)
Livsstil
4
2
0
-2
-4
-6
-8
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Year of treatment
Diabetes Prevention Program Research Group. N Engl J Med. 2002;346:393-403.
Livsstilsintervention ± Medicin
Wadden et al . N Engl J Med 2005;353: 2111-20
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Genetik?
GENETICS?
Tværsnitsdata og årsagssammenhænge
2008 HjerteStatistik - Fokus på køn og social forskelle
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Omsorgssvigt - longitudinelt
 Klasselærerens vurdering af hjemmets interesse og
støtte for barnet i 10 års alderen
 Viser en stærk sammenhæng med senere udvikling af
fedme i ung voksenalderen (10 år senere).
 Børn med ringe forældreinteresse har 7 gange forøget
risiko for at udvikle fedme i ung voksenalder i forhold
til børn, hvis forældreinteresse er harmonisk.
Lissau I, Sørensen TI. Lancet 1994;343(8893):324-7.
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Klinisk vejledning for almen praksis
Opsporing og behandling af overvægt hos voksne
Dansk Selskab for Almen Medicin i samarbejde med Sundhedsstyrelsen
2009
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Tak for opmærksomheden
“Better to walk in darkness than to follow a false light.”
(Voltaire 1694-1778)